With type-1 diabetes um the immune system for reasons we’re unclear about, destroys those insulin-producing cells.

Narration: The pancreas contains little structures called “Islets”, which house the insulin-producing cells. These are destroyed in type-1 diabetes, and insulin levels become insufficient.

Associate Professor O’Connell: It affects people very early in life and they have it all their life.

Narration: Insulin injections can regulate sugar levels, but your own islet cells regulate them second by second rather than just a few times a day.

Associate Professor O’Connell: I think if we’re ever going to beat this disease, then we have to take a radical approach. And that’s to replace the cells that have been destroyed, and not just replace the insulin.

Narration: Three major hospitals have banded together and set up an islet cell transplant program.

It’s still in the experimental phases and only a select number of diabetics qualify for the procedure. Barbara was one of them.

Maryanne: This is the room where the crucial part of the process happens. When a donor pancreas becomes available, it’s brought into this room, at any time of the night, and the islet cells are isolated in sterile conditions. The whole process can take up to 8hrs.

Associate Professor O’Connell: If it’s thought to be suitable for transplantation, we will then call the patient in and take them up to the operating theatre and infuse the insulin producing cells, the islet cells.And the procedure compared to a pancreas transplant procedure is very simple and straight forward.

Hi Barbara, how are you. It all went well, very straight forward.

Narration: For the first time in over 40 years, Barbara was making her own insulin.

Maryanne: Were you amazed?

Barbara: After five days it was heaven, sort of thing, you know, no insulin.

Maryanne: This would’ve been the first time in over forty years that you weren’t …

Barbara: It was. So it was very odd because you’d get up in the morning, yes, you’d still do your bloods, so you’re looking around, okay, I’ve got to do my insulin, oh no, you don’t have to do insulin, so that, that was it.

Associate Professor Phil O’Connell: It was very exciting. Both, for Barbara and for all of us. We were, we were ecstatic.

Narration: Barbara is one of only a handful of patients to have had islet cells transplanted. But the procedure is still far from perfect.

There are three major hurdles. Firstly, too many cells die soon after being injected. Secondly, those that do survive can be attacked by the immune system. And lastly, there’s a chronic shortage of islet cell donors.

Maryanne: Here at the Garvan Institute, they’re working out ways to increase the survival of islet cells.

Shane why is it that up to half the cells die within a few days of transplantation?

Dr Shane Grey: There’s thought to be a lot of reasons for why the islets are dying. One of them relates to the fact that when they get put in the liver, they, they don’t receive the same blood supply they’re used to, and so they actually suffer from lack of nutrients and adequate oxygen supply. So we’ve actually been looking at islet cells to see what genes they have to protect themselves when they are under extra stress.

Narration: A gene called A20 helps protect cells from immune attack.

Research with mice has shown that inserting this gene into islet cells results in a dramatic improvement in survival rates.

Dr Grey: We’re finding that we can turn an 80% fail rate into an 80% success rate, by genetically engineering islet cells to express um this particular gene called A20. So that’s actually very promising for dealing with some of the major issues for like human clinical islet transplantation.

Narration: Even if the survival of islets improves, there’s still the problem of these cells being attacked by the immune system.

Maryanne: Scientists at the prince of Wales are working out ways to avoid using anti-rejection drugs.

Narration: These scientists are using microcapsules to surround the islets and protect them from immune attack.

Maryanne: So what’s happening in the hood?

Professor Bernie Tuch: Jane’s mixing human islets, which have been isolated from a donor pancreas, and she’s mixing them with this product from seaweed called alginate.

Narration: The alginate capsules have pores that are large enough to let insulin escape, but small enough to prevent immune attack.

Professor Tuch: And it’s these capsules, these large numbers of these capsules, which will be placed into a person with type one diabetes, with a view of trying to get them off insulin, but without the need for anti rejection drugs.

Narration: A small study saw encapsulated islet cells transplanted into three patients, and the results were encouraging.

Professor Tuch: In the patients we discovered that in the first few days that insulin human insulin was being produced. Where as in these people who had no insulin previously. And in some cases they went hypoglycaemic because too much insulin was being produced.

Narration: Unfortunately, there hasn’t been any long-term success with encapsulating islets yet, but the trial proved its safe in small numbers of people in the short term.

But that still leaves the last and perhaps biggest hurdle of all… A dire shortage of pancreas donors.

Maryanne: Here at St Vincent’s hospital in Melbourne, scientists think they have a solution for the shortage of human islet cells.

Professor Tony D’Apice: If you can make pig islet to human transplants work, the donor issue becomes a non-issue.

Narration: Islets taken from pigs are genetically engineered in the laboratory with a series of carefully selected genes.

Professor D’Apice: What you’d hope is that you get pig islets that can be transplanted with minimal risk of rejection with a high chance of success and if you do need to immunosuppress the recipient you give them substantially less immunosuppression than you would even a human transplant.

Maryanne: But some people have a problem with having pig cells transplanted into their body.

Professor D’Apice: Well, it’s not compulsory. Ah, you know. People will … There’ll be people who will, and people who won’t. And, ah, I’m not going to inflict it onto anybody who doesn’t want it.

Maryanne: But is there a risk of transmission, of pig diseases into humans?

Professor D’Apice: Yes, there are, there are, in everything we do there are risks. The most infectious people to you and I are other people, not pigs. I mean, you are far more dangerous to me than a pig is, in terms of the risk of infection.

Narration: Despite the risks, major advances are being made in type 1 diabetes research on many fronts.

But for Barbara, being an islet transplant recipient didn’t turn out the way she would have hoped.

Maryanne: So Barbara, where are we today with your diabetes?

Barbara: Back to square one. Um back on insulin – four times a day.

Narration: For a year and a half, Barbara felt what it was like to be free of insulin injections.

The reasons why her procedure ultimately failed remain unclear, but at least it gave her a chance to take a glimpse into the future.

Associate Professor O’Connell: These things do take a long time to develop, but when they do develop, um, they can save thousands of lives.

Maryanne: So no regrets in taking part in the trial though?

Barbara: No, no.

Somebody's got to be a guinea pig somewhere along the line. Um I have no regrets. They've learnt a lot, so that's okay.

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peter - 22 Apr 2010 2:11:59pm

Icelet cells are a major problem to deliver insulin to infuse glucose to the mussel tissue. I have been watching Denise Faustman, MD., Ph.D. in her reserch to a cure. It would be fantastic to have Denise on Catalyst and talk about her findings towards a very possible cure.

laurin - 08 Jan 2010 11:26:18pm

I have read about the connection between mould causing diabetes. I was wondering if removing all traces of moulds from the body could increase chance of successfull transplant.

I also read that apple cider vinegar lowers sugars and that raw foods are a possible cure.

Candice Lloyd - 11 Apr 2010 8:35:50pm

Hi Laurin, look up Sergei Boutenko, raw food and diabetes and the book There is a Cure for Diabetes by Gabriel Cousens or go to his website for further information. There is also the DVD Simply Raw: Reversing Diabetes There are a few documented cases of people curing type 1 with raw foods.

Brandon - 17 Nov 2009 8:14:07pm

Hey I'm Brandon I'm 15 living with type1 diabetes I live in Western Australia is there any trails or something going on over here that i can put my and up for. I really want to get rid of this, I'm still growing i still a few more years left to grow and i want to go back to eating anything and everythingSo please consider me please

Vanessa - 16 Jul 2011 11:50:14am

Brandon, you can still eat what you want but just increase your units of insulin. Did your specialist not tell you this?

Shane - 09 Oct 2009 2:31:36pm

I have had type 1 diabetes since 18 yeas of age I am now 29 it sux I would give the earth to be able to control blood sugar levels as normal I was a top line afl player but had to give it up due to the effects of diadetes. How con I get on the trial studies I would love to put my hand up.

dieter braun - 28 Jan 2009 2:30:57pm

hello i have just been diagnosed with type 1 diabetes. It seems to me that there are two possibilities why the islets are being destroyed by the immune system. Either the islets have been stained by infection/sugar residues and therefore look foreign or the immune system as a result of the same trigger has modified its standards for response.Possibly one other cause, and that may be that because the islets have been damaged to a degree, they are no longer neutral, the repair process is so (for want of a better word) toxic that the body cant balance repair of the cells and removal of the toxins and so niether are fully completed. So in the end, without a transplant could i just have immune suppresants and possibly cure my diabetes by giving the cells that i have left a chance to regenerate to a level where the immune system no longer recognizes any threat.

Cucarola - 05 Mar 2009 10:15:29am

There was a test where type 1 diabetics remaining islets were removed - the immune system surpressed and the islets reinserted - I think with a success. The immune system did not attack the reinserted islets.

YUCHI - 30 Apr 2009 1:13:06am

If the test was successful, the other way may be possible. Keep remaining islets by immunosuppressants for a while, and then stop immunosuppressants.